Financial assistance for fertility preservation at cancer diagnosis: An analysis of the LIVESTRONG Fertility program.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6555-6555 ◽  
Author(s):  
Lenore Omesi ◽  
Aditi Narayan ◽  
Rebekkah Schear ◽  
Joyce Reinecke ◽  
Jennifer Levine
Keyword(s):  
Cancer Patients ◽  
Fertility Preservation ◽  
Cancer Diagnosis ◽  
Financial Burden ◽  
Insurance Coverage ◽  
Cost Savings ◽  
The United States ◽  
Financial Assistance ◽  
Adolescent And Young Adult ◽  
Medication Costs

6555 Background: Fertility preservation (FP) is a critical component of comprehensive adolescent and young adult (AYA) cancer care that is discussed and/or offered to only a fraction of eligible patients. Barriers include lack of insurance coverage making FP prohibitively expensive for many patients. The Sharing Hope program, now known as LIVESTRONG Fertility, was created by Fertile Hope in 2004 and acquired by LIVESTRONG in 2009. LIVESTRONG Fertility provides financial assistance to AYA cancer patients through discounted FP rates and access to free medications through a pharmaceutical company. Our aims were to review demographic characteristics of patients served, identify geographic utilization patterns, and quantify the program’s financial impact. Methods: De-identified records maintained by Fertile Hope/LIVESTRONG from 2004 to 2011 were retrospectively reviewed. Patient population, treating institutions and cost savings/patient were summarized using descriptive statistics. Results: 1171 men and 1319 women were approved for financial assistance between 2004 and 2011. Median age was 24 years (range 12-67) for men and 30 years (range 13-49) for women. The most common diagnoses included testicular cancer (34%) and Hodgkin Lymphoma (HL) (18%) among males and breast cancer (48%), HL (13%) and genitourinary cancers (13%) among females. Applications were received from individuals residing in 49 of the United States, as well as Washington DC and Puerto Rico. The applicants received care from a total of 1,245 cancer centers. For men, $438,711 was saved, averaging $375/patient. For women, $3,904,303 was saved in practitioner cost and $4,665,775 in medication costs averaging $6,497/patient. Conclusions: Financial assistance for FP at the time of a cancer diagnosis for AYAs is a persistent and growing need. Female cancer patients face significantly greater costs to preserve fertility. Further studies are needed to determine the true financial burden to patients and the degree to which lack of financial resources and insurance coverage prevent FP in this population. [Table: see text]

Fertility and cancer: Understanding the barriers to accessing information and resources.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 116-116
Author(s):  
Aditi Narayan ◽  
Carla Bann ◽  
Katherine Treiman ◽  
Cindy Soloe
Keyword(s):  
Fertility Preservation ◽  
Cancer Diagnosis ◽  
Financial Burden ◽  
Insurance Coverage ◽  
Survivorship Care ◽  
Cancer Treatments ◽  
Survey Results ◽  
Financial Issues

116 Background: Some cancer treatments may lead to infertility in individuals diagnosed during their reproductive years. Infertility can affect a cancer survivor’s long-term quality of life by causing depression as well as reduced life satisfaction and increased anxiety. Addressing fertility concerns is a major component of survivorship care. Methods: In 2017 LIVESTRONG launched a national survey to assess whether patients are being informed about potential fertility risks due to a cancer diagnosis and/or related treatments; whether they are receiving necessary education and access to resources to make informed decisions about fertility preservation; and the financial burden of fertility preservation. A total of 1,064 people diagnosed with cancer between ages of 15-39 during 2006 to 2017 responded to the survey. Results: Seventy-nine percent of respondents said a health professional had discussed fertility issues with them, but only 51% were referred to a fertility specialist. Respondents diagnosed between 2011 and 2017 were more likely to report fertility discussions compared to those diagnosed between 2006 and 2010 (84% vs. 69%; p<.001), and to be referred to a fertility specialist (58% vs. 33%, p <.0001). More educated respondents and those with health insurance at time of diagnosis were more likely to report fertility discussions than those who did not (96% vs. 85%; p=.04). The most frequently discussed topics were possible risks to fertility (89%), methods of fertility preservation (70%), whether the respondent wanted any/or more children (64%), and timing for fertility preservation (50%). Insurance and financial issues were less frequently discussed: costs of fertility preservation (37%), insurance coverage (26%), and financial assistance (30%). Forty-four percent did not take steps to preserve their fertility. Conclusions: Many respondents reported not preserving fertility before treatment because they were not referred to a fertility specialist (30%) or insurance did not cover the costs (20%). All patients diagnosed in their reproductive years should be informed of infertility risks and receive information/resources on preservation options, regardless of education, income level, and insurance status.

Changes in employment and insurance for patients with cancer receiving safety net services.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 104-104
Author(s):  
Nicole Caston ◽  
Courtney Williams ◽  
Alan James Balch ◽  
Kathleen D. Gallagher ◽  
Gabrielle Betty Rocque
Keyword(s):  
Cancer Patients ◽  
Prescription Drugs ◽  
Financial Burden ◽  
Insurance Coverage ◽  
Safety Net ◽  
Financial Assistance ◽  
Categorical Variables ◽  
Income Loss ◽  
Patients With Cancer ◽  
The Impact

104 Background: Under-resourced patients with cancer often face financial burdens due, not only to costs of treatment, but also from side effects that prevent individuals’ ability to work, which impact employment status and may cause insurance coverage loss. Financial assistance may be sought from safety net programs, which provide both material support and financial counseling. However, knowledge of the impact of cancer on employment and insurance in a population seeking safety net services is limited. Methods: This observational, cross-sectional study uses data on safety net services from a nationwide survey conducted in July 2017 and distributed by the Patient Advocate Foundation (PAF). The survey respondents included patients with cancer who received services from PAF from July 2016 to June 2017. Descriptive statistics were calculated using frequencies for categorical variables. Results: A total of 508 patients with cancer completed the survey. Most patients had a diagnosis of breast cancer (47%), followed by myeloma (13%), and prostate cancer (8%). The majority of patients reported that their illness affected their employment (67%); by either job loss (13%), income loss (24%), or inability to work as usual (27%). Of these patients, 27% lost their insurance coverage. Those able to enroll in a new insurance plan reported having more expensive rates (40%) and fewer covered services (36%) compared to their previous coverage. The most commonly utilized governmental safety net services were Social Security Disability Insurance (19%) and Medicaid (12%). Non-governmental safety net services such as financial assistance from non-profits (27%) and free medication from drug companies (13%) were also frequently used. Beyond their insurance coverage, cancer patients still needed assistance paying for diagnostic tests (18%), clinic visit fees (23%), and prescription drugs (15%) from the safety net program. Conclusions: Cancer patients commonly experience financial burden due to losses in employment and insurance, resulting in need for safety net programs. Further work is needed to identify approaches to reducing the adverse financial impact of cancer care.

Identifying levels of financial toxicity and unmet needs in cancer patients receiving financial assistance: Exploring trends in populations lacking adequate resources to overcome healthcare barriers.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 151-151
Author(s):  
Brittnee Barris ◽  
Katie Deehr ◽  
Eric Anderson ◽  
Kathleen D. Gallagher ◽  
Shonta Chambers ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Financial Burden ◽  
Treatment Costs ◽  
Cost Of Care ◽  
Financial Assistance ◽  
Categorical Variables ◽  
Racial Groups ◽  
Financial Toxicity ◽  
Major Barrier ◽  
Medication Costs

151 Background: The inability to afford healthcare has a widespread effect on cancer patients, notably impacting treatment decisions and outcomes. Patients receiving financial assistance to offset medication costs still face challenges overcoming cost of care barriers. This study investigated sources of concern and financial stress among racial groups and identified solutions to address patients’ needs beyond medication-related costs. Methods: This cross-sectional study utilized secondary survey data collected from cancer patients who received co-payment and/or financial aid from PAF in 2018. Respondents answered questions describing their financial distress and the COmprehensive Score for financial Toxicity (COST) tool (0-44 with lower scores indicating worse toxicity). Descriptive statistics were calculated using means and standard deviations (SD) for continuous variables and frequencies for categorical variables. Two sample t-tests were used for bivariate comparisons between racial groups. Results: Of 494 cancer patients surveyed, 72% were Caucasian, 11% were African American (AA), and 71% indicated a household income of < $48,000. Although this population received financial assistance, cost of medications was still a major barrier to adhering to treatment (59% vs 69%). AA patients reported greater financial burden caused by cost of deductibles/copay/coinsurance (58% vs 50%) and treatment costs not covered by insurance (49% vs 21%). AA patients highly rated day-to-day living expenses as an unmet need (64% vs 40%). COST scores differed significantly between Caucasian (mean 17.7, SD 8.6) and AA cohorts (mean 12.1, SD 8.6; p < .001), driven by the inability to meet monthly expenses at all (35% vs 11%). Of AA, 80% felt they do not have enough money in savings/retirement to cover treatment costs. Overall, the AA cohort reported higher frustration with not being able to work or contribute as much as usual (45% vs 26%). Conclusions: Under-resourced AA cancer patients identify a need for a comprehensive approach to cost of care conversation, to drive better adherence and improved treatment outcomes.

O-180 Oocyte vitrification for fertility preservation does not delay the initiation of neoadjuvant chemotherapy for breast cancer

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
I Sellami ◽  
M Grynberg ◽  
A Benoit ◽  
C Sifer ◽  
A Mayeur ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Cancer Diagnosis ◽  
Ovarian Tissue ◽  
Young Patients ◽  
Oocyte Retrieval ◽  
Breast Cancer Patients ◽  
Oocyte Vitrification

Abstract Study question Does oocyte vitrification for fertility preservation (FP) delay the initiation of neoadjuvant chemotherapy for breast cancer? Summary answer The indication of neoadjuvant chemotherapy for breast cancer should not be considered as an impediment to urgent oocyte vitrification for FP. What is known already FP is considered as one of the most important issues to address for young breast cancer patients. Cryopreservation of oocytes or embryos may be considered after controlled ovarian hyperstimulation (COH) or in vitro maturation (IVM). Pregnancies have been reported after reutilization of oocytes frozen following both procedures. Although oocyte competence is better after COH, this strategy requires on average 13 days to be achieved. In addition, the safety of ovarian stimulation before tumor removal is currently not formally established. In case of neoadjuvant chemotherapy, the risk-benefit balance of COH is not well known. Study design, size, duration Retrospective cohort study including all breast cancer patients eligible for oocyte vitrification following COH or IVM before initiation of neoadjuvant chemotherapy between January 2016 and December 2020. Participants/materials, setting, methods Inclusion criteria were: female patients with confirmed non metastatic breast cancer, 18 to 40 years of age, with indication of neoadjuvant chemotherapy, who have had oocyte retrieval for FP after COH or IVM +/- cryopreservation of ovarian tissue. Various time-points related to cancer diagnosis, FP or chemotherapy were obtained from medical record review. Main results and the role of chance A total of 198 patients with confirmed breast cancer who had oocyte retrieval following COH (n = 57) or IVM +/- cryopreservation of ovarian tissue (n = 141) for FP prior to neoadjuvant chemotherapy were included. Although women in IVM group were significantly younger as compared to patients who underwent COH (31.7 ± 4.2 vs. 33.3 ± 4.0 years, p = 0.019), ovarian reserve parameters, BMI and cancer stage did not differ between the two groups. Overall, the average time from cancer diagnosis to chemotherapy start was similar between patients having undergone COH or IVM before oocyte vitrification (37.3 ± 13.8 vs. 36.9 ±13.5 days in COH and IVM groups respectively, p=0.857). Limitations, reasons for caution The time from referral to FP consultation may have influenced the type of FP. In addition, the retrospective nature of the present analysis may constitute a limitation. Moreover, the efficiency and security of the different FP strategies used has not been analysed. Wider implications of the findings Oocyte vitrification following COH or IVM was not associated with delayed breast cancer treatment in the neoadjuvant setting, so long as there was a prompt FP referral. Young patients undergoing neoadjuvant chemotherapy should be informed of these findings to avoid unnecessary anxiety due to concern for delays. Trial registration number Not applicable

Abstract 18272: The Increasing Proportion of Acute Myocardial Infarction Represented by the Uninsured: a Growing Financial Burden in the United States

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bethany Doran ◽  
Yu Guo ◽  
Jinfeng Xu ◽  
Sripal Bangalore
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Health Insurance ◽  
Financial Burden ◽  
Insurance Coverage ◽  
The United States ◽  
The Us ◽  
Hospital Stays ◽  
Nationally Representative ◽  
The Cost

Introduction: Under the provisions of the Affordable Care Act, insurance coverage will markedly increase with the Congressional Budgetary Office estimating the number of insured to increase by approximately 13 million in 2014 and 25 million in 2016. However, approximately 31 million non-elderly US citizens are expected to remain without health insurance in 2016. Acute myocardial infarction (AMI) remains a source of significant morbidity and mortality, as well as cost to society. No prior studies have examined temporal rates of uninsured among patients presenting with an AMI using a nationally representative database. Hypothesis: We tested the hypothesis that the proportion of uninsured individuals with AMI and cost of uninsured to society will vary by year. Methods: We used the Nationwide Inpatient Sample (NIS), which contains estimates from approximately 8 million hospital visits and information related to number of discharges, aggregate charges, and principal diagnoses of all patients discharged in the US. We calculated the percentage of acute myocardial infarction by insurance status, and the sum of all charges of hospital stays in the US adjusted for inflation. Results: The cost to society due to acute myocardial infarction in the uninsured increased substantially from 1997 to 2012, with total cost in 1997 of $852,596,272 and $3,446,893,954 in 2012 after adjustment for inflation. In addition, although rates of AMI decreased in the general population (from 268.6/100,000 individuals in 1997 to 193.8/100,000 individuals in 2012), the proportion of individuals with AMI who were uninsured increased (from 3.83% in 1997 to 7.37% in 2012). Conclusions: The proportion of those experiencing AMI who are uninsured is rising, as is cost to society. It remains to be seen what the effects of expanding health insurance will have on the rate of AMI as well as proportion of AMI represented by the uninsured.

Risk of acute renal failure among breast cancer patients and chemotherapy treatment of breast cancer patients with a history of renal insufficiency in a commercially-insured population in the United States

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22104-e22104 ◽  
Author(s):  
W. J. Langeberg ◽  
C. D. O'Malley ◽  
C. W. Critchlow ◽  
J. P. Fryzek
Keyword(s):  
Breast Cancer ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Insufficiency ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
The United States ◽  
First Year ◽  
Breast Cancer Patients ◽  
History Of

e22104 Background: Risk of acute renal failure (ARF) among breast cancer (BC) patients may increase with nephrotoxic chemotherapy and other exposures, but this risk is not well characterized. Furthermore, among patients who present with renal insufficiencies (RI) at cancer diagnosis, subsequent treatment patterns are not well described. Methods: We performed a retrospective cohort study using a large national commercial claims database. The cohort included all women diagnosed with BC from 2000 to 2007 who were 18–64 years at diagnosis with no history of cancer (n=13,296). We defined a diagnosis of BC as at least one inpatient or two outpatient claims more than 30 days apart with an ICD-9 code of 174. Among patients with no history of RI (n=13,150), we calculated the cumulative incidence (CI) of ARF_the proportion with at least one inpatient or two outpatient claims with an ICD-9 code of 584 or 586 in the first year following cancer diagnosis. Treatment for BC patients with a history of RI (n=146) was also assessed. Results: Among BC patients with no history of RI, 0.3% were diagnosed with ARF within a year after cancer diagnosis. The CI of ARF was higher in patients with metastases: 0.7% for any metastasis, 2.3% for bone metastasis, and 0.1% for no metastasis. The CI of ARF among patients undergoing radiation or mastectomy was similar to the overall rate (0.3%) but was higher in patients receiving nephrotoxic chemotherapy (1.0%) or intravenous bisphosphonates (IV BPs) (2.1%). The CI of ARF was higher in patients with congestive heart failure (1.4%), diabetes (0.9%), and/or hypertension (0.8%) at cancer diagnosis compared to patients without these comorbidities (0.2%). Among BC patients with a history of RI, 7.5% were administered nephrotoxic chemotherapy, 30.1% received potentially nephrotoxic chemotherapy, and 1.4% were given IV BPs. Conclusions: Breast cancer patients who present with comorbidities, develop metastases, or are given nephrotoxic chemotherapy or IV bisphosphonates are at higher risk of acute renal failure in the first year after breast cancer diagnosis. More research is warranted on the treatment of breast cancer patients with a history of renal insufficiency. [Table: see text]

Psycho-Oncology: Cancer patients with past suicide attempts, or a family history of suicide.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23173-e23173
Author(s):  
Daniela Gercovich ◽  
Ernesto Gil Deza ◽  
Flavio Tognelli ◽  
Carlos Fernando Garcia Gerardi ◽  
Claudia Lorena Acuna ◽  
...  
Keyword(s):  
Family History ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Illicit Drugs ◽  
Suicide Attempts ◽  
The United States ◽  
Population Characteristics ◽  
History Of ◽  
Psychological Risk

e23173 Background: “The suicide rate in cancer patients is twice that observed in the general population in the United States” (JNCI vol 100, 24, page 1750, 2008). This paper focuses ona population with great psychological risk: cancer patients (Pt) with previous suicide attempts (SA) or a family history of suicide (FS); both grouped under SAFS for the purpose of this study. Methods: Between 9/26/2012 and 11/28/2018 all new patients (Pt) admitted to IOHM filled out a Past Medical History Form (PMHF) (ASCO 2013 ABST. e17539) with their preexisting clinical conditions. The database was locked and anonymized. Those with a history of SAFS before cancer diagnosis were selected. Results: Out of 15,617 Pt, 184 Pt (1.2%) were SAFS(141 Pt were SA, 39 Pt were FS and 4 Pt were both). The relative risk ofSA was ten times larger for those with FS. Psychiatric Medication: Antipsychotics: 15Pt (8%), Antidepressants: 23 Pt (12%) and Benzodiazepines 45 Pt(24%), No treatment 101 Pt (55%). Population Characteristics: Sex: F:144 Pt . M: 40 Pt. Age: 56y (r = 26-88). Tumor Dx: Breast (65 Pt ) - Gastrointestinal (24 Pt) - Urological (21 Pt ) - Lung (21 Pt ) -Gynecological (19 Pt) - Hematological (11 Pt) -Head &Neck (8 Pt) - Endocrine (7 Pt) - Other (8 Pt). Stages: Early (0-I-II-III): 130 Pt, Advanced: 54 Pt. Ob-Gyn history:25 Pt (17%) nulliparous, 18 Pt (12%) with one child, 77 Pt (53%) with 2 or 3 children and 24 Pt (17%) with more than 3 children; 62 Pt (43%) had previous abortions. Average severe comorbidities (respiratory and psychiatric) was 3 per Pt (r = 0-18). Toxic habits: Smoking: 120 Pt (65%), Alcohol: 37 Pt (20%) and Illicit Drugs: 4 Pt (2%). Follow-up: 19 months (r = 0-70). No Pt had any SA, or commited suicide, during the follow-up.Living patients:177 (96%). Conclusions: 1) In our vast cohort, 184 Pt (1.2%) were identified as highly vulnerable psychiatric Pt due to SAFS. 2) Given the high psychological risk and stressful cancer diagnosis, 83 Pt (45%) were prescribed psychiatric drugs. 3) Follow-up of SAFS Pt by a multidisciplinary team is requiredfor adequate Pt and family support.

A pilot study of a comprehensive financial navigation program in cancer patients and caregivers.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 174-174
Author(s):  
Jordan Steelquist ◽  
Kate Watabayashi ◽  
Karen Overstreet ◽  
Tony Leahy ◽  
Alan James Balch ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cancer Patients ◽  
Financial Burden ◽  
Financial Education ◽  
Case Managers ◽  
Financial Assistance ◽  
Patient Advocate ◽  
Navigation Program ◽  
Medical Bills ◽  
The Impact

174 Background: Few studies have reported on interventions to alleviate financial toxicity (FT) in cancer patients (pts) and informal caregivers (cgs). We developed a financial navigation program in collaboration with Consumer Education and Training Services (CENTS), Patient Advocate Foundation (PAF), and Family Reach Foundation (FRF), to offer financial coaching, insurance navigation, and assistance with unpaid non-medical bills. We conducted a pilot study to assess feasibility of enrolling cgs with pts and to describe the assistance provided. Methods: Pts with any stage solid tumor actively receiving treatment (tx) at the Seattle Cancer Care Alliance were asked to identify a cg who could participate. Pts or pt/cg dyads received an online financial education course and monthly contact for 6 months (mo) with CENTS and PAF. Subjects were referred to FRF for assistance in paying non-medical bills. We describe pt and cg characteristics, and assistance provided by the program. Results: Of 54 pts approached, 30 (median age 59.5, 61% white, 97% stage III/IV disease) were consented. Most pts (53%) had income ≤ $25,000, and all were insured (48% commercial, 28% Medicare, 21% Medicaid). 18 cgs (67% spouse/partner) were consented. At consent, 55% of pts reported debt in the prior 3 mo. Mean score using the COST PRO FT measure (range 0-44, lower score = higher FT) was 17.4 at baseline. After pts’ physical health, out-of-pocket costs were the most stressful aspects of tx for cgs. Cgs with high financial burden from caregiving more often reported taking on new debt, dipping into retirement accounts, or changing their jobs or hours. CENTS coaches assisted with budgeting, updating wills, and employment rights counsel. PAF case managers assisted with financial assistance for drugs, cost of living (e.g. transportation), disability applications, and secured $6,950 in debt relief. FRF dispersed $4,133, primarily for housing expenses. Conclusions: Implementing a financial navigation program that engages both pts and cgs is feasible. This lower income, financially stressed population received $11,000 in financial assistance. Future work will focus on evaluating the impact of this program on financial and psychosocial outcomes in pts and cgs.

Sign in / Sign up

Export Citation Format

Share Document